Dual current pathway atrial defibrillation apparatus

Abstract

An implantable system for the defibrillation of the atria of a patient's heart includes a first pair of atrial defibrillation electrodes configured for delivering a first atrial defibrillation pulse along a first current pathway in the heart, and a pulse generator operatively associated with the first pair of atrial defibrillation electrodes for delivering the first atrial defibrillation pulse. A second pair of atrial defibrillation electrodes configured for delivering a second atrial defibrillation pulse along a second current pathway in the heart is also included, with the second current pathway being different from the first current pathway. A pulse generator is operatively associated with the second pair of atrial defibrillation electrodes for delivering the second atrial defibrillation pulse after the first defibrillation pulse.

That which is claimed is: 
     
       1. An implantable system for the defibrillation of the atria of a human patient's heart, said system comprising: a first pair of atrial defibrillation electrodes configured for delivering a first atrial defibrillation pulse along a first current pathway in said heart;   a pulse generator operatively associated with said first pair of atrial defibrillation electrodes for delivering said first atrial defibrillation pulse at not greater than 8 Joules;   a second pair of atrial defibrillation electrodes configured for delivering a second atrial defibrillation pulse along a second current pathway in said heart, with said second current pathway different from said first current pathway; and   a pulse generator operatively associated with said second pair of atrial defibrillation electrodes for delivering said second atrial defibrillation pulse at not greater than 8 Joules and after said first defibrillation pulse and without intervening monitoring of the efficacy of the first defibrillation pulse.   
     
     
       2. A system according to claim 1, wherein said first pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the right atrium or superior vena cava of said heart; and   a defibrillation electrode configured for positioning in the distal coronary sinus or great cardiac vein of said heart.   
     
     
       3. A system according to claim 1, wherein said second atrial defibrillation pulse follows said first atrial defibrillation pulse by 0 to 500 milliseconds. 
     
     
       4. A system according to claim 1, wherein said second pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the proximal coronary sinus of said heart; and   a defibrillation electrode configured for positioning anterior to the left atrium of said heart.   
     
     
       5. A system according to claim 1, wherein said second pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the left pulmonary artery of said heart; and   a defibrillation electrode configured for positioning in the right ventricle of said heart.   
     
     
       6. A system according to claim 1, wherein said second pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the distal coronary sinus of said heart; and   a defibrillation electrode configured for positioning in the right ventricle of said heart.   
     
     
       7. A system according to claim 1, wherein said second pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the left pulmonary artery of said heart; and   a defibrillation electrode configured for positioning in the right atrium of said heart.   
     
     
       8. A system according to claim 1, wherein said second pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the left pulmonary artery of said heart; and   a defibrillation electrode configured for positioning in the distal coronary sinus of said heart.   
     
     
       9. A system according to claim 1, wherein said second pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the proximal coronary sinus of said heart; and   a defibrillation electrode configured for positioning in the right atrium of said heart.   
     
     
       10. A system according to claim 1, wherein said second pair of atrial defibrillation electrodes comprises: a defibrillation electrode configured for positioning in the proximal coronary sinus of said heart; and   a defibrillation electrode configured for positioning in the distal coronary sinus of said heart.   
     
     
       11. A system according to claim 1, further comprising: a monitoring electrode configured for monitoring the electrical activity of the ventricles of said heart, and   a controller connected to said monitoring electrode configured for controlling the time of delivery of said first defibrillation pulse.   
     
     
       12. A system according to claim 11, wherein said monitoring electrode is configured for positioning in the right ventricle of said heart. 
     
     
       13. A system according to claim 1, said pulse generator including a switch, with said switch programmable to alter the coupling of said pulse generator to said atrial defibrillation electrodes. 
     
     
       14. A system according to claim 1, with said pulse generator including a capacitor and a switch operatively associated with said capacitor, said switch configured to deliver a biphasic pulse as said first atrial defibrillation pulse and a biphasic pulse as said second atrial defibrillation pulse. 
     
     
       15. An implantable system for the defibrillation of the atria of a human patient's heart, said system comprising: a first defibrillation electrode configured for positioning in the right atrium or superior vena cava of said heart;   a second defibrillation electrode configured for positioning in the distal coronary sinus or great cardiac vein of said heart;   a pulse generator operatively associated with said first and second defibrillation electrodes for delivering a first defibrillation pulse not greater than 8 Joules between said first and second electrodes;   a third defibrillation electrode configured for positioning in the proximal coronary sinus of said heart;   a fourth defibrillation electrode configured for positioning anterior to the left atrium of said heart; and   a pulse generator operatively associated with said third and fourth defibrillation electrodes for delivering a second defibrillation pulse not greater than 8 Joules between said third and fourth electrodes after said first defibrillation pulse and without intervening monitoring of the efficacy of the first defibrillation pulse.   
     
     
       16. A system according to claim 15, further comprising a first catheter, said first catheter having said second defibrillation electrode and said third defibrillation electrode connected thereto. 
     
     
       17. A system according to claim 16, further comprising a monitoring electrode configured for positioning in the right ventricle of said heart, and a controller connected to said monitoring electrode configured for controlling the time of delivery of said first defibrillation pulse. 
     
     
       18. A system according to claim 17, further comprising a second catheter and a third catheter, said second catheter having said first defibrillation electrode and said fourth defibrillation electrode connected thereto,   said third catheter having said monitoring electrode connected thereto, and with   said fourth defibrillation electrode configured for positioning in the pulmonary artery.   
     
     
       19. A system according to claim 17, further comprising a second catheter and a third catheter, said second catheter having said fourth defibrillation electrode connected thereto,   said third catheter having said monitoring electrode and said first defibrillation electrode connected thereto, and with   said fourth defibrillation electrode configured for positioning in the pulmonary artery.   
     
     
       20. A system according to claim 17, further comprising a second catheter and a third catheter, said second catheter having said first defibrillation electrode connected thereto,   said third catheter having said monitoring electrode and said fourth defibrillation electrode connected thereto, and with   said fourth defibrillation electrode configured for positioning in the pulmonary artery.   
     
     
       21. A system according to claim 17, further comprising a second catheter, said second catheter having said first defibrillation electrode said monitoring electrode, and said fourth defibrillation electrode connected thereto, and with   said fourth defibrillation electrode configured for positioning in the pulmonary artery.   
     
     
       22. A system according to claim 17, further comprising a second catheter, a third catheter, and an implantable housing having said first pulse generator and said second pulse generator contained therein,   said second catheter having said first defibrillation electrode connected thereto,   said third catheter having said monitoring electrode connected thereto, and   said housing having said fourth defibrillation electrode connected thereto, and with said housing configured for implantation anterior to the left atrium of the heart.   
     
     
       23. A system according to claim 15, further comprising an atrial fibrillation detector, and wherein said pulse generator is operatively associated with said atrial fibrillation detector and configured for delivering said first defibrillation pulse upon the detection of atrial fibrillation. 
     
     
       24. A lead for insertion into the heart of a patient for use in combination with an atrial defibrillator, said lead comprising: an elongate catheter flexibly configured for insertion down the superior vena cava of the heart, into the right atrium, through the right ventricle, and into the pulmonary artery to achieve an operable configuration therein;   a first atrial defibrillation electrode connected to said catheter; and   a second atrial defibrillation electrode connected to said catheter;   said first and second atrial defibrillation electrodes spaced apart on said catheter so that, when said catheter is in said operable configuration,   said first atrial defibrillation electrode is positioned in the right atrium of the heart; and   said second atrial defibrillation electrode is positioned in the pulmonary artery; and   a third electrode connected to said catheter; said third electrode spaced apart from said first and second atrial defibrillation electrodes so that, when said catheter is in said operable configuration, said third electrode is positioned in the left ventricle of the heart.   
     
     
       25. A lead according to claim 24, wherein said third electrode is a monitoring electrode.